Training Community Health Workers to Improve Infant and Child Health in Rural Benin

Training Community Health Workers to Improve Infant and Child Health in Rural Benin

The West African nation of Benin faces many challenges in achieving Millennium Development Goal 4---reducing child mortality. In the rural communities in Benin (91% of the population live in rural areas), access to health care and treatment is inadequate in relation to the vast need. Very few people have the appropriate skills and capacity to deliver care in these areas. The US Agency for International Development's (USAID) BASICS Benin project is increasing the capability of villages as far as 50 km away from health centers by training Community Health Workers (CHWs) to perform community case management of children five years-old and under.

In October and November 2010, BASICS Benin trained 857 CHWs from rural communities in five pilot zones (Kandi-Segbana-Gogonou, Banikoara, Djougou-Ouake-Copargo, Bassila, and Tchaourou), increasing the total to 1,048 trained CHWs. In many of the targeted communities, the distance and availability of transportation to health centers creates an obstacle to delivering basic medical care to children with common treatable diseases that contribute to the high rate of mortality in children under five. Now that more CHWs are trained, they can provide the first line of care to children in rural areas.

The BASICS Benin child survival program focuses on community empowerment for prevention and treatment of malaria, pneumonia, diarrheal diseases, and malnutrition. To maximize the health impact of each CHW, BASICS Benin uses evidence-based methods of performing home visits. The two goals of CHW home visits are case management of sick children, and the delivery of health promotion messages. Each CHW leaves the training equipped with the skills needed to gain the confidence of members within their community and to communicate disease treatment and prevention messages.

BASICS Benin has established close relationships with local NGOs familiar with the unique social and geographical challenges of each health zone. One specific advantage to this arrangement is that CHW volunteer motivation can be monitored at a closer level by the local NGOs.

Within the first few months, CHWs recorded over 4,900 home visits, primarily managing the care of infants with symptoms of malaria.

Within the five health zones covered by BASICS, the mortality rate of severe malaria in children under the age of five ranges between 3.7% - 41.8%. During the months following their training, CHWs identified and referred 81 cases showing danger signs of malaria, diarrheal, or respiratory infection to a local health center. Many of these children would have likely remained at home without receiving any type of palliative care as more than half of deaths in children less than five years-old still occur at home in rural Benin.

BASICS Benin, a USAID funded project led by MSH, is collaborating with the Benin Ministry of Health and its partners to address malaria, diarrhea, nutrition, and immunizations in five health zones through grants to nongovernmental organizations. BASICS Benin is working to: increase access to a package of community-based services including malaria, diarrhea and ARI treatment, health education for vaccination and improved nutrition; strengthen referral between community-level and health centers; and, create effective partnerships between NGOs and health zone management groups.

Otchaileo Lola Gandaho is a Technical Child Health Advisor on the USAID BASICS Benin project. Kaj Gass, a Peace Corps volunteer, also contributed to this article.

Comments

What a great program. It is great to see community members becoming part and parcel of solutions that improve child health, and helping reduce the incidences of children dying from treatable disease like malaria or diarrhea.
Helen Keller International has been utilizing a similar model to treat Onchocerciasis, called "Community-Directed Treatment with Ivermectin (CDTI)" that places the power to control this blinding disease in the hands of community members themselves.